Ovarian Suppression in Premenopausal Breast Cancer: Medical vs. Surgical Options

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• Ovarian Suppression Overview
• Choosing BSO Surgery
• Choosing LHRH Agonists
• Available Medications
• Insurance Barriers
• Full Transcript

Ovarian Suppression Overview

Premenopausal women with breast cancer often require ovarian function suppression. This treatment reduces estrogen production from the ovaries. Dr. Marc Lippman, MD, explains this is a cornerstone of hormone therapy. Two primary methods exist for achieving this crucial therapeutic goal.

Patients can undergo medical suppression using specific drugs. Alternatively, a surgical procedure called bilateral salpingo-oophorectomy (BSO) is an option. The choice between these paths is not always straightforward.

Choosing BSO Surgery

Bilateral salpingo-oophorectomy is a definitive surgical solution. Dr. Marc Lippman, MD, notes it is often rationally chosen for specific patient groups. Women with a known genetic risk for breast cancer may opt for this procedure.

BSO also significantly reduces the risk of developing ovarian cancer. For these high-risk patients, removing the ovaries offers a dual benefit. It treats the current breast cancer and provides proactive cancer prevention.

Choosing LHRH Agonists

LHRH agonists offer a reversible method of ovarian suppression. Dr. Marc Lippman, MD, emphasizes this is critical for younger breast cancer patients. Many women diagnosed at a young age wish to preserve future fertility options.

Medical suppression allows for the possibility of having children later. This is a key advantage over the permanent nature of BSO surgery. The decision heavily depends on the patient's personal life goals.

Available Medications

Common LHRH agonists include Goserelin and Leuprolide. These drugs are also known as GnRH agonists. They work by suppressing the signals that tell the ovaries to produce estrogen.

Dr. Lippman confirms these are the two main useful drugs for this indication. Both are effective at achieving medical castration. The mechanism provides a chemical alternative to surgical ovary removal.

Insurance Barriers

Dr. Marc Lippman, MD, identifies a major obstacle in breast cancer care. Insurance companies frequently dictate the chosen ovarian suppression method. They often refuse to pay for a physician's preferred medication.

This leads to "peer-to-peer" discussions that are a source of physician burnout. These conversations are with insurance-employed doctors who may lack specific expertise. Dr. Lippman describes this interference as a critically horrible aspect of healthcare that endlessly makes practicing physicians crazy.

Full Transcript

Dr. Marc Lippman, MD: When breast cancer happens in premenopausal women, production of estrogen by the ovaries can be suppressed by medications and also by surgical removal of ovaries. Medications are LHRH agonists, or GnRH agonists, such as Goserelin and Leuprolide. Surgery is called BSO, bilateral salpingo-oophorectomy.

Dr. Anton Titov, MD: How are LHRH agonists used?

Dr. Anton Titov, MD: How to choose between medical and surgical suppression of ovarian function in breast cancer?

Dr. Marc Lippman, MD: Ovarian suppression method is probably not rationally chosen. Some women, particularly younger women, may already be at genetic risk of breast cancer. They are happy to have their ovaries out. BSO, bilateral salpingo-oophorectomy makes sense because they are at risk of ovarian cancer.

The second issue is that some much younger women with breast cancer eventually would like to potentially go back and have children. If your ovaries are out, that's a little bit tricky to do. Those people would be better served by suppression of ovarian function.

There are two main drugs that are useful. To be honest with you, it's mostly determined, extremely unfortunately, by insurance companies. They say we will pay for one drug and not for the other breast cancer treatment drug. I mean, that's nonsense.

That's one of the critically horrible aspects of healthcare in this country. I'm just gonna get on a soapbox here. You can't stop me. You can just edit this out of the conversation.

And that is that. You can look at reasons why physicians quit medicine or burn out. One of the most common reasons given is endlessly dealing with third-party payers. It is trying to justify prescriptions with so-called peer-to-peer discussions with insurance company-employed MD s.

Discussions are with people who are not your peers and don't know what they're talking about, how to treat patients. Eventually, it gets practicing physicians going crazy.

I've had any number of situations where I put a patient on Lupron. Insurance company will say, no, no, you can use the other breast cancer therapy drug. And you ask, why? And they say, because that's what we're going to pay for. It endlessly makes you crazy, endlessly makes you crazy.